11 Gordon’s Functional Health Pattern

7.HEALTHPERCEPTION/ HEALTH MANAGEMENT

a. How would you describe your usual health status?
b. Are you satisfied with your usual health status?
c. Tobacco use? Number of packs per day?
d. Alcohol use? How much and what kind?
e. Street drug? What and how much? f. Any history of chronic disease? Describe Immunization History?
h. Have you sought any health care assistance in the past year? Why?
I. Current work & how would you rate your working conditions
J. How would you rate living condition at home
k. Do you have any difficulty securing any of the following services?
L. Medications (over the counter & prescription)
J. Have you followed the routine prescribed for you?
k. Have you had any accident/injuries/falls in the past?describe
k. Have you had any problems with cuts healing?
L. Do you exercise on a regular basis? Type&Frequency?
m. Do you have any suggestions or requests for improving your health? Describe
n. Do you do (breast/testicular) self-examination? How often?

8. NUTRITIONAL-METABOLIC
a. Any weight gain& gain in the last 6 months? How many?
b. How would you describe your appetite? c. Do you have any food intolerance/restrictions?Describe.
d. Describe an average day's food intake for you
(meals/snacks)?
e. Describe an average day's fluid intake for you.
f. Describe food likes and dislikes.
g. Would you like to gain or lose weight?
h. Any problems with: Nausea, vomiting, swallowing.chewing, indigestion
i. Would you describe your usual lifestyle?
j. For breastfeeding mothers only: Do you have concerns about breast feeding? Describe

9. ELIMINATION PATTERN .
A. What is your usual frequency of bowel movements?
B. Character of Stool: character, color and bleeding?
C. History of constipation?
D. History of diarrhea?
E. History of Incontinence?

10. ACTIVITY END RICE PATTERN

a. How does the client pervive her his self-care
b. How many pillows the you sleep on
c. Do you experience fatigue or weakness?
d. Occupation
e. Describe your usual leisure time activities/lobbies
F. Any problem with concentration Describe
11. SLEEP REST PATTERN
a. Usual sleep habits? Describe.
b. . Problems: difficulty going to sleep? Awakening at night, early awakening? Insomnia?
c. Methods used to promote sleep: medication, warm fluids, techniques
 12. COGNITIVE-PERCEPTUAL PATTERN
a. Pain: PORST
b. Perception of decision making?
c. Knowledge level: current problems, restate current therapeutic regimen
13. SELF-PERCEPTION AND SELF-CONCEPT PATTERN
a. What is your major concern at the current time?
b. Do you think this admission will cause any lifestyle and result in any body changes for you?
c. What is your visual of yourself?
d. Do you believe you will have any problems dealing with your current health situation? Describe
e. On a scale of 0-5 rank your perception of your level of control in this situation
f. On a scale of 0-5 rank your usual assertiveness level.

14. ROLE-RELATIONSHIP PATTERN

a. Status of your patient. If married, rate your parenting skills
b. Any loses: physical, psychologic, social in past year?
C. How is the patient handling this loss at this time?
d. Do you believe this admission will result in any type of loss?
e. Do you think this admission will cause changes in family role?
F. How would you rate your usual social activities?
g. How would you rate your comfort in social situations?
h. What activities or jobs do you like and dislike to do?Describe

15. SEXUALITY-REPRODUCTIVE PATTERN

a. Female:are you taking Birth Control Measures, history of vaginal discharge?
c. Both problems in sexual functioning, sexual relationship. Describe
d. Do you believe this admission will have any impact on sexual functioning? Describe

16. COPING-STRESS TOLERANCE PATTERN

a Have you experienced any stressful or traumatic events?
b. How would you rate your usual handling of stress?
c. What is the primary way you deal with stress or problems?
d. Have you used any counseling groups in the past year!
e. What do you believe is the primary reason behind this admission
F. Do you seek health assistance at the first symptom?
g. Are you satisfied with the care you have been receiving?

17. VALUE-BELIEF PATTERN

a. Are you satisfied with the way your life has been developing?
b. Will this admission interfere with your plans for the future?
c. Religion? Any religious restrictions to care?
d. Will this admission interfere with your spiritual or religious practices?
e. Have your religious beliefs helped you to deal with problems in the past?